Complications of Browlift Techniques: A Systematic Review

BACKGROUND: There is ongoing debate over which surgical technique is the safest for brow elevation. OBJECTIVES: The authors outline complication rates for a variety of open and endoscopic browlift techniques based on the results of a literature review. METHODS: The following databases were searched to capture relevant studies: MEDLINE, EMBASE, CINAHL, LILACS, Web of Science, Cochrane Libraries, controlled-trials.com, and clinicaltrials.gov. Eighty-two studies met the inclusion criteria. Assuming between-study heterogeneity due to the limitations and biases inherent to case series, a random-effects model was used to calculate weighted proportions. Pooled weighted proportions with 95% confidence intervals were determined. RESULTS: All open and endoscopic procedures are associated with a variety of complications. Unacceptable scarring and paresthesia are the most common complications among all surgical browlifts. For anterior hairline incision with subcutaneous dissection, alopecia occurred in 8.5% of patients, paresthesia in 5.4%, unacceptable scarring in 2.1%, and skin necrosis in 1.8%. For coronal incision with subgaleal dissection, unacceptable scarring occurred in 3.6% of patients, hematoma in 0.5%, and infection in 0.2%. Endoscopic techniques with subperiosteal dissection had the highest complication rates: 6.2% for paresthesia, 3.6% for asymmetry, 3.0% for alopecia, and 2.7% for lagophthalmos. CONCLUSIONS: Although complication rates vary with respect to incision site and plane of dissection, endoscopic techniques are associated with a larger variety of complications than open approaches. The findings should be interpreted with caution due to the limitations inherent to a case series. A well-designed comparative study is needed to evaluate the "true" rate of complications among the various browlift techniques.